Healthcare Provider Details

I. General information

NPI: 1588652705
Provider Name (Legal Business Name): J CHRIS HUMMEL MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 MCAULEY BLVD
OKLAHOMA CITY OK
73120-8347
US

IV. Provider business mailing address

4205 MCAULEY BLVD STE 401
OKLAHOMA CITY OK
73120-8347
US

V. Phone/Fax

Practice location:
  • Phone: 405-755-6111
  • Fax: 405-755-6298
Mailing address:
  • Phone: 405-755-6111
  • Fax: 405-755-6298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number19601
License Number StateOK

VIII. Authorized Official

Name: CYNTHIA LEA FREITAG
Title or Position: ADMINISTRATOR
Credential:
Phone: 405-755-6111